ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
Managing waste in the NHS needs a strategic approach
NHS London Procurement Partnership (LPP) has been working to support NHS organisations to improve their management of waste since 2012. Edward James, senior workstream lead for Estates, Facilities & Professional Services at LPP, discusses some of the challenges being faced, and the ways in which LPP supports NHS organisations to overcome them
LPP has had a waste management framework in place since 2012 and, since then, has supported 45 organisations in awarding contracts worth a total of some £50 million. The contracts which have been awarded include multimillion pound managed service contracts as well as small specific contracts for confidential waste. The framework covers all waste streams that can be produced in the NHS from clinical waste, to recycling and ambulance depot waste such as oils.
In the early days of the framework, trusts saw an average savings of 25 per cent on waste management costs. What has become apparent over the past few years is that the costs for waste management have stopped reducing, and are now increasing. Suppliers are seeing increases in staff costs, fuel costs and energy costs to run their waste plant, and they are now passing these costs back to their customers. LPP has been working with a number of NHS organisations to benchmark what this means to them and their current contract and contract prices.
The chances of NHS organisations going back out to market and achieving a lower price without doing anything different are very low. Consequently, we have supported our members to look strategically at their waste management, and to consider their recycling rates, in both clinical and non-clinical waste streams, and those of best-in-class NHS organisations. We have shown on a number of occasions that by implementing good waste management strategies, the likely cost pressures can be offset and in some cases savings delivered.
Award-winning strategy for GSTT
Some of the benefits to be had under the framework are proving to be award-winning. Guy’s & St Thomas’ NHS Foundation Trust, one of the country’s largest acute trusts, awarded a contract to Bywaters. Bywaters provides a complete managed service to Guy’s & St Thomas’, which includes the management of a number of waste operatives on site as well as dedicated “green gurus” supporting the Trust to improve its waste management and carbon footprint.
The traceability and tracking of waste on site allows the trust to track waste back to department level and reward those departments who recycle the most waste, whilst at the same time segregating waste properly. This work has been recognised nationally, with both parties winning a Green Apple Award.
As well as supporting large acute hospitals such as Guy’s & St Thomas’, LPP has also supported five ambulance services across the country. The challenges faced by the ambulance service are very different to the challenges of an acute hospital. Ambulance services have a large number of small, geographically dispersed stations which do not produce enough waste to warrant regular collections. They struggle with space to house bins on site, and a lack of availability of staff to sign waste collection notes can result in collections failing to be made. One of the other big issues for the ambulance service is that there is often not enough space on board an ambulance to have different bins allowing for segregation into various streams.
LPP worked closely with East Midlands Ambulance Service to find a new solution which would standardise the approach to waste management at their more than 70 locations, and significantly reduce their landfill waste. The resulting service included a standardised collection, changes to the way in which bins could be provided on the vehicles, and how these linked to the bins available on site. A full training package for staff taught them how to optimise the improvements to be had from the changes. This detailed work has seen East Midlands Ambulance Service able to improve segregation of waste, reduce its landfill waste, and reduce the cost of waste management.
The public sector and the challenge of… the public
One of the difficulties that the NHS – like all public-facing organisations – has is the public. Organisations can deliver training to in-house staff on how to segregate waste, but the challenge is how to ensure that those visiting your premises support your organisation in waste segregation. To help understand how others are dealing with this issue, LPP joined a supplier on a site visit at Gatwick Airport to look at their approach to engaging the public in waste segregation. What became clear from the site visit was the importance of clear and simple signage, which meant people do not spend long periods of time working out in which bin to place their waste. Simple, but effective.
Since we launched the original waste framework in 2012, there have been a number of developments within the clinical waste market. The move towards reusable sharp bins, for example, rather than incinerating has increased in pace significantly over the years, and a number of providers now provide appropriate waste solutions. ‘Offensive’ waste has also become more important to organisations looking to identify lower cost waste streams for their non-infectious clinical waste.
There is still a large difference in the approach taken by NHS trusts in the classification of offensive waste and the agreement of infection control practitioners. This seems to be resulting in some trusts not sending any waste to an offensive waste stream. Others, however, are getting close to what the market says is the maximum that can be achieved, with up to 40 per cent of all clinical waste being classified as ‘offensive’. With a £250 per tonne difference between the cost of offensive and infectious waste, it is a savings opportunity which all trusts should be exploring.
Is collaboration on waste management workable?
LPP has also noticed a larger number of NHS organisations looking to collaborate on waste management. There should be a level of caution taken with this approach. In any collaboration it is important to look at the cost drivers for suppliers. In the waste market this is people, vehicles, fuel and plant. If collaboration does not reduce the number of resources required to deliver the contract, cost reductions cannot be achieved – more does not mean less.
If an acute trust is filling a lorry on each collection, collaborating with the hospital next-door will not deliver savings as there is no reduction in the quantity of waste being generated, the same number of staff are required in the process, and the same number of vehicles and journeys need to be made. For smaller trusts who do not fill a lorry, consideration needs to be given on route planning for the supplier and if resources can actually be removed from collaborative work.
On a more positive note, collaboration can work very well where one trust has a mature waste management policy and training programme, and a neighbour doesn’t. Why reinvent the wheel? Learn from those who are doing well. This approach can minimise waste being produced in the first place, drastically cutting cost.
The service offered by LPP through our framework is to support customers in awarding contracts, and to provide support in managing those contracts once awarded. This ongoing work within the waste market allows LPP Category Managers to develop a deep understanding of the market and the opportunities that exist, and enables them to share knowledge between different contracting authorities.
LPP renewed its waste framework in 2017 and took a number of the lessons learnt to ensure its new framework was up to date. We are lucky to have been working with a number of fantastic suppliers for a number of years. Before tendering the new framework we undertook a number of 1:1 sessions with suppliers on our framework, and new entrants too, to ensure we built a robust and successful replacement framework.
Managing waste water
LPP is now in the process of working on waste of another kind. In conjunction with the London Energy Project, we are offering our members the opportunity to maximise benefits to be had from the deregulation of the non-household water market. In short, we’re developing a further competition to be run under the Crown Commercial Service 'Water, Wastewater and Ancillary Services framework' (RM3790). More than 35 London-region local authorities and other public sector bodies have already committed to participating in this contract. If all our London region NHS members joined, that could more than double the number of public sector organisations taking part.
Savings to be had from the cost of supply are minimal, but what we will be looking to achieve is a contract which brings the benefits of ancillary services at no added cost. These services will include water conservation, leak detection and repair, legionella risk assessments, the reduction of water consumption in order to deliver environmental improvements, efficiency, financial and consumption savings.
This is a very exciting project for us to be involved in – one that we believe will have London leading the way in managing water resources for the public.